5 Fast Facts From the 2017 MPFS Final Rule

Fri, Dec 9, 2016


2017 MPFS

Digesting the hundreds of pages in the MPFS 2017 Final Rule is best done in small bites. Here are five tidbits to get you started.

1. The Conversion Factor Goes Up a Little

The 2017 conversion factor is just a bit bigger than the 2016 conversion factor:

  • 2016: 35.8043
  • 2017: 35.8887.

Read about it: You’ll find the conversion factor listed on page 374 of the Final Rule PDF.

2. Non-F2F Prolonged Services Get Some Respect

In a change from 2016, Medicare will offer separate payment for prolonged services codes 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and +99359 (… each additional 30 minutes [List separately in addition to code for prolonged service]).

Caution: Do not count time more than once. If the time is included in another MPFS service you’re reporting, don’t report the prolonged service codes, too.

Read about it: The MPFS offers insights into proper use of these codes on page 59 of the Final Rule PDF.

3.  CMS Has a List of 0-Day Global Codes & Is Checking It Twice for Mod 25

Codes with 0-, 10-, and 90-day global periods include reimbursement for E/M services routinely provided with the service or procedure. CMS has been seeing certain codes with 0-day global periods billed frequently (half of the time or more) with E/M codes. Because the E/M codes have modifier 25 (Significant, separately identifiable E/M service on the same day…) appended, they get separate reimbursement. Medicare wants to be sure those service and procedure codes often paired with an E/M are properly valued. The proposed rule listed 83 codes to check. The final rule shortens the list significantly.

Read about it: Check out Table 8 on page 37 of the Final Rule PDF.

Bonus tip: Discussion of data collection requirements for 10-day and 90-day global periods starts on p. 40 of the Final Rule PDF.

4. HCPCS Is the Home of Telehealth Consult Codes

Medicare created G0508 (Telehealth consultation, critical care, physicians typically spend 60 minutes communicating with the patient and providers via telehealth [initial]) and G0509 (Telehealth consultation, critical care, physicians typically spend 50 minutes communicating with the patient and providers via telehealth [subsequent]).

The codes allow you to report telehealth services for critical care, such as in the case of stroke.

Read about it: Discussion of these codes starts on p. 183 of the Final Rule PDF.

5. Programs Like MDPP Put Primary Care in the Spotlight

The Final Rule confirms an expansion of the duration and scope of the Medicare Diabetes Prevention Program (MDPP). The goal of the program is to prevent type 2 diabetes in beneficiaries with pre-diabetes. Prevention has been seen as a way to keep patients healthier and reduce Medicare expenses.

Read about it: Get comfortable, and dig into the long discussion starting on p. 290 of the Final Rule PDF.

What Do You Think?

Do you review the MPFS Final Rule, or do you tend to focus on day-to-day MPFS data for codes, like global periods and allowed modifiers?

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Solve the Mystery of the CPT® 2017 Urology Updates

Tue, Dec 6, 2016


solving the mystery of urology CPT 2017 updates

You’ve got to put on your detective hat and use your “little grey cells” to search out many of the CPT® 2017 changes for urology. If you don’t know where to look, you may miss what’s new. Dig into the details of these three changes.

1. Find the New Note Under 55700

If you concentrate your 2017 prep on just code changes, you’ll miss the update to an instruction under 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach).

In CPT® 2016, you’ll find this note with 55700:

  • If imaging guidance is performed, use 76942.

In 2017, you’ll find a revised note:

  • If imaging guidance is performed, see 76942, 77002, 77012, 77021.

The change acknowledges the various kinds of guidance the physician may use and confirms that you may report the guidance in addition to the biopsy:

  • 76942, ultrasound guidance
  • 77002, fluoroscopic guidance
  • 77012, CT guidance
  • 77021, MR guidance.

2. Unveil the Cat. III Timeline

Forgetting to check Category III CPT® codes for changes could also lead you to miss some codes appearing in the print manual for the first time. Examples include:

  • 0421T, Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed)
  • 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance
  • +0443T, Real time spectral analysis of prostate tissue by fluorescence spectroscopy.

But remembering to check Cat. III isn’t the real detective work here. The real clues to understanding these codes are in the timeline for Cat. III.

Code 0421T was implemented Jan. 1, 2016, and 0438T and +0443T were implemented July 1, 2016. So you may be wondering why those codes are marked as new in the CPT® 2017 manual. The short version is that Cat. III codes are temporary codes for emerging technologies and services, so they have a semi-annual early release schedule. In other words, Cat. III codes come out on a schedule that differs from the annual CPT® update publication calendar, so not all implemented Cat. III codes make it into the manual by publication time. (But your online coding tools should update throughout the year.)

3. Put a Magnifying Glass to Moderate Sedation Changes

Many coders looking at the list of 2017 code changes were mystified by the number of codes marked as revised that had no apparent change to their descriptors. The answer was that the revision was the removal of the moderate sedation symbol, indicating you must report a moderate sedation code separately in 2017 to get paid for providing that service with the procedure.

Plenty of urology codes will be affected by this change, including codes for percutaneous renal biopsy and ablation, internally dwelling ureteral stent services, nephroureteral and nephrostomy catheter services, and others. So be sure to get to know the new rules for reporting moderate sedation to ensure you get every dollar your practice deserves in 2017.

What Do You Think?

Do you prefer a short list of CPT® changes or were you hoping for changes that didn’t happen? What do you think about the moderate sedation change?

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Do You Know When to Choose CPT® 2017 Lumbar Device Code 22867 Instead of 22869?

Fri, Dec 2, 2016


CPT 2017 lumbar stabilization device coding

In CPT® 2017, there are four new codes for insertion of lumbar stabilization and distraction devices. They replace two soon-to-be deleted Cat. III codes. So why did your options double? Here’s the answer to that question and more to help you ease in to 2017.

Swap Your Search for Distraction Device to Cat. I

2016 codes: In 2016, you had these lumbar stabilization codes in Category III of CPT®, but you now should add them to your 2017 deleted CPT® codes list:

  • 0171T, Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; single level
  • +0172T, … each additional level (List separately in addition to code for primary procedure).

2017 codes: As of Jan. 1, 2017, these services move on up to Category I as part of the CPT® updates. Here’s the list of CPT® code changes for 2017:

  • 22867, Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
  • +22868, … second level (List separately in addition to code for primary procedure)
  • 22869, Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
  • +22870, … second level (List separately in addition to code for primary procedure).

Get a Handle on What Makes Each Code Unique

Watch your combos: Code +22868 is an add-on code for primary code 22867, while +22870 is an add-on code for primary code 22869.

The construction of the new 2017 CPT® codes allows you to report one code per lumbar level.

Use 22867 (single level) and +22868 (second level) for services performed with open decompression, but without fusion.

Use 22869 (single level) and +22870 (second level) for services performed without open decompression or fusion.

Tip: Open decompression is the factor that differentiates your code choice, so watch for that in the documentation.

Heed CPT® 2017 Guidelines for When Codes Are NOT Allowed

Guidelines include a long list of codes you should not report in conjunction with the new codes.

The codes listed below are forbidden for both 22867/+22868 and 22869/+22870:

  • Arthrodesis codes 22532-+22534, 22558, 22612, +22614, 22630-+22634, 22800-22804
  • Spinal instrumentation codes +22840-+22842
  • Laminectomy codes 63005, 63012, 63017
  • Laminotomy codes 63030, +63035, 63042, +63044
  • Laminectomy, Facetectomy, and Foraminotomy codes 63047, +63048
  • Fluoroscopy code 77003.

Helpful hint: Fluoroscopy code 77003 isn’t the only guidance code to keep off your claim. The new code descriptors state that the services include imaging guidance when performed.

And don’t miss: Codes 22867 and +22868 have the added instruction that you should not report them in conjunction with 22869 and +22870.

Round Out Your Know-How With RVU Update

The 2017 Medicare Physician Fee Schedule (MPFS) Final Rule offers some insights into the valuation of these codes, just as it does for many of the 2017 CPT® code changes.

For example, here are the work RVUs you can expect these codes to have in the new year and how they compare to the recommendation from the AMA/Specialty Society Relative Value Update Committee (RUC):

  • 22867, 13.50 (lower than the RUC recommendation of 15.00)
  • +22868, 4.00 (same as the RUC recommendation)
  • 22869, 7.03 (lower than the RUC recommendation of 7.39)
  • +22870, 2.34 (same as the RUC recommendation).

How About You?

Did you use the Cat. III codes? Are you excited to have the new Cat. I options?





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The Quick, CMS-Approved Way to Avoid a MACRA Penalty

Tue, Nov 29, 2016


MACRA positive or negative payment adjustment

If you’ve been trying to wrap your head around MACRA for a while, you may be at the point where you’re willing to give up hopes of a bonus if you could just be sure you won’t face penalties.

Good news: As long as you submit a little something to the Quality Payment Program, you won’t have to worry about a negative payment adjustment. Check out these reporting options, and then be sure to use the list of MACRA resources at the end to rev up your preparations. That bonus may be within your reach after all.

Know the Consequences of Your Reporting Choices

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) involves a shift to value-based payment models. The new related Quality Payment Program (QPP) has two tracks:

  • Advanced Alternative Payment Models (APMs)
  • Merit-based Incentive Payment System (MIPS).

The expectation is that most physicians will start in MIPS, which includes elements of the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VM or VBM), and the Medicare Electronic Health Record incentive program (also called Meaningful Use).

CMS is offering a “Pick Your Pace” approach to MIPS. If MIPS is the program for you, the option you choose to follow in 2017 will determine the impact on your Medicare payments in 2019.

  • Don’t participate: If you don’t submit any 2017 data, expect a negative payment adjustment.
  • Submit something/test: This choice is your quick road to avoiding a penalty. You must submit some data, such as one quality measure, to avoid a downward payment adjustment. This option helps ensure that your system is working and that you’re ready to participate at a higher level in 2018 and beyond.
  • Submit a partial year: Submitting 90 days of 2017 data to Medicare will also keep you safe from a penalty and may even bring you a positive payment adjustment. This option means you can begin after Jan. 1, 2017, if you need more time to prepare.
  • Submit a full year: Submitting a full year of QPP data is your best chance for a bonus.

Add to Your Reimbursement by Getting to Know MACRA

You’ve been through changes before, and you really can manage to do it again. There are a lot of resources available to help you:

  • CMS: From CMS’s MACRA: MIPS & APMs site, you can access a QPP site. Don’t miss the Education page, which includes resources like a Where to Go for Help Fact Sheet.
  • AMA: The AMA has a MACRA site that includes an assessment tool.
  • Specialty societies: Check your specialty society for information specific to your practice. For instance ACC and AAFP have MACRA resources.
  • Webinars/Seminars: There are a variety of options available to learn about MACRA from experts, so think about what level of understanding you need to have of MIPS and APMs, and find a seminar or webinar that offers the level of training you require.
  • AAPC: AAPC offers a MACRA category in its Knowledge Center with informative articles and helpful updates.

How About You?

What track and pace are you choosing for MACRA?

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Thanksgiving Sale! With 25% Savings, Getting All Your 2017 Coding Resources Is Easy as Pie

Wed, Nov 23, 2016


SuperCoder Thanksgiving sale

Happy Thanksgiving! We at SuperCoder know that we wouldn’t be here without you and your dedication to doing your job well. As one way of saying thank you for all you do, we’re offering 25 percent off of our SuperCoder products.

Online coding resources provide automatic 2017 updates:

  • Code Search: Enter a search term, find your code.
  • Fast Coder: Benefit from code search plus essential compliance tools.
  • Physician Coder: Boost your know-how with a specialty newsletter tied to your code search and tools.
  • Multispecialty Coder: Want code search and tools, but one specialty newsletter isn’t enough? Choose your own articles from our large selection of newsletters.
  • Intuitive Coder: Discover a streamlined way to home in on the right ICD-10 orthopedic code without scanning and scrolling through long code lists.

The publications you love are available at 25 percent off, too:

  • Rapid Coder: Pinpoint the right ICD-10-CM code faster on specialty-specific, quick-reference charts.
  • TCI coding manuals: See how The Coding Institute experts enhance code-set manuals to ensure maximum usefulness for coders.
  • Specialty Guides: Keep the focus on your specialty with codes, descriptors, lay terms, Medicare data, illustrations, and more in these feature-packed guides.

Claim Your Savings Today

Check out our Thanksgiving Sale page to claim your discount and stock up on the resources you trust.

Enter code THANKS25, and be sure to place your order by Nov. 30, 2016, when the offer ends.

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Tighten Up Your Documentation for Coding E/M Based on Time

Mon, Nov 21, 2016


coding E/M based on time

If you almost always choose your E/M codes based on history, exam, and medical decision making (HEM), you may be hesitant to code based on time. But ignoring this opportunity could be leading you to report lower level E/M codes that reimburse at a lower rate than you deserve. Take your time-based coding confidence up a notch with these documentation tips.

Tip 1: Know What the Authoritative Rule Says

The first step to knowing what documentation is required is simple: read the official rule. It’s in the E/M guidelines section of the CPT® manual under the heading “Select the Appropriate Level of E/M Services Based on the Following.”

In short, the rule states that when a provider spends more than 50 percent of an encounter on counseling and/or coordination of care, then you can use time as the controlling factor to determine the E/M level. In the office setting, this refers to face-to-face time. Floor/unit time counts in a hospital or nursing facility.

The rule also states, “The extent of counseling and/or coordination of care must be documented in the medical record.”

Tip 2: Look for Total Time and Time on Counseling

To feel secure that coding an E/M based on time will stand up to scrutiny, work with providers to document both total time for the encounter and the amount (or percentage) of time spent on counseling and/or coordination of care. Using start and stop times for both the visit total and the counseling portion is another good method, and some EHRs may have features to help with this.

Do this: Documentation that “I saw this patient face-to-face for 27 minutes and spent 15 minutes of the encounter on counseling the patient” shows the provider spent more than 50 percent of the 25-minute visit on counseling.

If this is an office visit for an established patient, the mention of 15 minutes counseling during a 27-minute encounter helps support reporting 99214 (…Typically, 25 minutes are spent face-to-face with the patient and/or family) even if the HEM calculation doesn’t meet the complete requirements for this level 4 code.

Don’t do this: Saying “I had a long talk with the patient” isn’t going to cut it when an auditor checks to see if more than half the visit was spent on counseling.

Tip 3: Check for a Description of What Occurred

Just offering the time involved isn’t enough. Medicare’s 1995 and 1997 E/M documentation guidelines state that “the record should describe the counseling and/or activities to coordinate care.”

The description may detail discussing topics like the patient’s diagnosis, prognosis, and treatment options.

A template can be useful to help show the provider exactly what information you need to see documented, but avoid text that’s tempting to cut and paste. Auditors may see cookie-cutter text as a sign they need to dig deeper. The documentation of the counseling and coordination of care should be specific to the patient and should support medical necessity for spending the reported time with that patient.

How About You?

Do you code E/M based on time? What steps have you taken to ensure adequate documentation?

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CCI 2017 Manual Provides Shoulder Arthroscopy Answers You’ve Been Waiting For

Fri, Nov 18, 2016


The 2017 CCI manual is here!

You know you’re a coder when news that the new Correct Coding Initiative (CCI) manual is out makes you a little giddy. (There’s a good chance I said the same thing about CPT® 2017 when it came out.) I’ve been watching for the CCI manual update ever since the deletion of certain shoulder arthroscopy edits raised questions about how to reconcile the edit change with instructions in the manual.

If you code for shoulder services, be sure to get familiar with these CCI manual updates. (And for the rest of you, be sure to check out the changes to your own chapters. The manual marks updates in red italics.)

Quick recap: The orthopedic edits that got deleted in 2016 bundled extensive debridement (29823) with shoulder arthroscopy procedure codes 29824, 29827, and 29828. This deletion left coders wondering about a conflicting 2016 CCI manual instruction that says not to report debridement with same-joint arthroscopy.

Start With the General Rule

Chapter 4 of the CCI manual is where you’ll find CCI guidelines specific to codes 20000-29999. Section E is about Arthroscopy.

The 2017 manual adds a new subsection 4 that states, “CMS considers the shoulder to be a single anatomic structure.” The CCI guideline goes on to state that when you have a CCI edit involving two shoulder arthroscopy codes, the general rule is that you should not override the edit for services on the ipsilateral, meaning same side, shoulder.

There are three exceptions, though, and, for more on that, subsection 4 points you to subsection 7. I’ll go over the exceptions toward the end of the post. Spoiler alert: The three exceptions relate to the three deleted edits.

Shoulder Joins Knee in Excepted Joints List

Because the 2017 manual adds subsection 4 (described above), the 2016 subsection 4 becomes 2017 subsection 5. The point of mentioning that is: Shoulder coders should be aware of wording in the new subsection 5.

This is the subsection with the trouble-making 2016 rule that essentially says you shouldn’t report debridement when performed in the same joint as an arthroscopy procedure. The 2016 manual lists only the knee as an exception.

The 2017 version brings the subsection in line with the edit deletions by adding the shoulder as an exception: “With the exception of the knee and shoulder, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter.”

Exception Twist: Watch for Different Area of Same Shoulder

You’ll find the most helpful information in new subsection 7. Here’s the breakdown:

  • Shoulder arthroscopy procedures include limited debridement, such as 29822, even if the debridement and procedure are in different areas of the same shoulder
  • Shoulder arthroscopy procedures include extensive debridement, such as 29823, even if the debridement and procedure are in different areas of the same shoulder, BUT there are three exceptions:
    • “CPT® codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT® code 29823 if the extensive debridement is performed in a different area of the same shoulder.”

So there you have it. Be sure you remember both the general rule and when you can apply the exceptions to help keep your shoulder claims compliant.

How About You?

Were you surprised or happy about any of the CCI manual changes? How would you complete the sentence: You know you’re a coder when …?

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ICD-10 Quick Quiz: What’s Your Thanksgiving Style?

Tue, Nov 15, 2016


ICD-10 Thanksgiving quiz

We’ve still got a little more than a week until Thanksgiving (although I had to double check after seeing my neighbor’s inflatable Santa village go up a couple of weeks ago). Here’s a just-for-fun ICD-10 quiz to predict how your Thanksgiving will go.

1. The day before Thanksgiving, you’re most likely to be:

A. Cleaning so much you risk T55.0X1A (Toxic effect of soaps, accidental [unintentional], initial encounter)

B. Doing your best to stir up Z63.1 (Problems in relationship with in-laws)

C. Coding so fast you just might get an injury from Y93.C1 (Activity, computer keyboarding)

2. In the kitchen on Thanksgiving, you’re most likely to have:

A. G56.03 (Carpal tunnel syndrome, bilateral upper limbs) from mashing potatoes following weeks of trying to find the best recipe

B. M54.2 (Cervicalgia) and H53.143 (Visual discomfort, bilateral) from craning your neck to keep an eye on the TV while you sneak tasty tidbits that someone else cooked

C. W26.2 (Contact with edge of stiff paper) when checking take-out menus during a coding work break results in a paper cut

3. During Thanksgiving dinner, you’re most likely to experience:

A. W18.2XXA (Fall in [into] shower or empty bathtub, initial encounter) when you’re rushing to get yourself cleaned up from all the cooking while everyone else sits down to eat

B. W27.4XXA (Contact with kitchen utensil, initial encounter) when your sister stabs you with a fork to keep you from stealing her stuffing

C. Y92.511 (Restaurant or café as the place of occurrence of the external cause) when your coding work-break take-out plans don’t pan out

4. After dinner, you’re most likely to qualify for:

A. T73.3XXA (Exhaustion due to excessive exertion, initial encounter) from handling everything from planning to clean up

B. R14.2 (Eructation) as you burp your compliments to the chef

C. W59.22XA (Struck by turtle, initial encounter) while out for a walk after a long day of coding

What’s Your Score?

If you answered mostly A: Thanks for all the work you do to make the holiday special. Here’s hoping you can delegate some tasks this year and get to enjoy Thanksgiving.

If you answered mostly B: Thanks for making things interesting and giving everyone else good fodder for stories. If your answer to number 3 was B, you may want to consider whether that stuffing is really worth a fork in the arm, though.

If you answered mostly C: Thanks for keeping the wheels of healthcare turning. Working on holidays is tough, so your willingness to step up is appreciated! Someone has to be ready to send in claims for T23.129A (Burn of first degree of unspecified single finger [nail] except thumb, initial encounter) when cooks catch their oven mitts on fire. (Not that I’ve ever managed to do that myself. Several times.)

How About You?

What ICD-10-CM code best sums up how you expect your Thanksgiving to go?




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